American Diabetes Association Scientific Sessions
Joseph Aloi,1 Raymie McFarland,2 Jadeesh Ullal,3 Melanie Mabrey,2,4 Kathy Price Ward3
Management of patients with steroid-induced hyperglycemia can be difficult. Intravenous insulin infusions are generally recommended for flexibility with dynamic insulin requirements. Blood glucose control in patients undergoing renal transplant is particularly difficult as high-dose steroids, immunosuppression and renal function each play an important but varying contribution to insulin resistance.
Record review: 11 patients treated with Glucommander IV (GM), a computerized IV insulin dosing algorithm, to examine the ability of GM to safely achieve glycemic targets versus standard insulin infusions (SII).
- Renal transplant
- 1 blood glucose (BG) >200 mg/dL or 2 BGs >180 mg/dL
- Treated with GM during the post-operative period
Glucose results were collected for the patient’s entire IV insulin treatment.
Prior to treatment with GM, patients’ mean BG was 200 mg/dL + 87; during treatment with GM patients’ mean BG was 163 mg/dL + 57. Patients continuing IV insulin with SII after GM discontinuation had a mean BG of 178 mg/dL + 60. Hypoglycemia <70 mg/dL was 2% prior to treatment with GM, 0.7% during treatment with GM, and 1% after discontinuation of GM. Percentage of glucose results in goal was 68% with GM versus 45% before and 55% after.
|BGs < 70||6||0.7%||> 0.1||2%||2|
|BGs 71-180||549||68%||< 0.0001||45%||38|
|BGs > 180||248||31%||< 0.0001||53%||45|
|Mean BG||163||< 0.0001||200|
|Standard Deviation||57||< 0.0001||87|
|BGs < 70||6||0.7%||> 0.7||1%||3|
|BGs 71-180||549||68%||< 0.0001||55%||165|
|BGs > 180||248||31%||< 0.0001||44%||133|
|Mean BG||163||< 0.0001||178|
|Standard Deviation||57||> 0.2||60|
Renal transplant patients treated with Glucommander achieved a higher percentage of BG results in goal, lower mean glucose levels, less hypoglycemia, and lower glucose variability compared to patients on SII.
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina.
- Glytec, Waltham, Massachusetts.
- Sentara Healthcare System, Norfolk, Virginia.
- Duke University School of Nursing, Durham, North Carolina.